Are comatose patients aware of people and conversations?

In the course of my personal injury law practice based in Atlanta, Georgia, often I have been called to meet with the family of a traumatic brain injury victim at a hospital intensive care unit, rehab facility or nursing home. Entering the room I see the patient in a coma or occasionally in a persistent vegetative state.

The family is uncertain whether their injured loved one is aware of anything. However, just in case the patient can pick up what s said, I have learned to keep conversation cheerful around the comatose patient, introduce myself to the patient and say we’re going to try to help. Then we take substantive discussion of the case to a conference room or empty waiting room.

Now there is a new study using fMRI brain imaging that shows some patients can display emotional reactions to pictures of loved ones. This new study is surprising because patients in this condition are unable to show signs of being aware of their surroundings. People who are in a persistent vegetative state can breathe on their own, sleep and wake up, but are unable to respond to what is going on around them.

The study placed four patients who were in a persistent vegetative state (PVS) in a brain scanner and showed them both pictures of strangers and people they knew. Their results were compared with those from a healthy control group. For two of the four PVS patients, the scans suggested emotional awareness to the people they knew.

“This experiment, a first of its kind, demonstrates that some vegetative patients might not only possess emotional awareness of the environment but also experience emotional awareness driven by internal processes, such as images.”

One patient, a 60 year old woman who had been hit by a car, showed brain activity in the emotional and face-processing areas of the brain when she looked at pictures of loved ones. Similar activity could also be seen when she was asked to imagine her parents’ faces.

Both patients that showed emotional awareness regained consciousness within two months of being tested. Neither could recount anything from when they were unconscious. It is possible that this test may provide a clue about the patient’s prognosis and even point the way towards useful therapies for those in a persistent vegetative state.

Ken Shigley is past president of the State Bar of Georgia (2011-12), double board certified in Civil Trial Advocacy and Civil Pretrial Advocacy by the National Board of Legal Specialty Certification, and lead author of Georgia Law of Torts: Trial Preparation and Practice. His Atlanta-based civil trial practice is focused on representation of plaintiffs in cases of castastrophic personal injuryand wrongful death.